Causes of brown discharge when taking Janine

pharmachologic effect

The contraceptive effect of Zhanine is based on the interaction of various factors, the most important of which are the inhibition of ovulation and changes in cervical secretion.

The progestational component of Janine, dienogest, is a powerful progestogen and is considered the only norethisterone derivative with antiandrogenic activity. Antiandrogenic data were also obtained from a clinical trial on a small number of patients suffering from acne inflammation. Dienogest has a beneficial effect on lipid composition by increasing HDL.

Higher doses of the drug (0.05 mg ethinyl estradiol) reduce the risk of uterine and ovarian cancer.

63 days scheme

“Janine” is used as a means of contraception, but sometimes it is recommended to drink it, for example, to treat adenomyosis or endometriosis. And at the same time, long-term use of “Janine” is often indicated according to the scheme of 63 days continuously. Quite often, a woman who has been prescribed to take “Janine” does not feel the best: vaginal discharge may be smeared with blood or dark brown secretions, body weight may increase, swelling of the extremities may occur, and tinnitus may appear. It all depends on individual sensitivity to the drug and sometimes it has to be discontinued.

Among the positive effects of “Zhanine”, it is worth noting the minimal risk of developing endometrial and ovarian cancer, reducing the pain of menstruation, reducing the duration of bleeding, eliminating signs of iron deficiency anemia, the drug has antiandrogenic activity, improves the lipid profile, which is expressed in an increase in the proportion of high-density lipoproteins.

Pharmacokinetics

Oral active ingredients are quickly and almost completely absorbed. Peak serum concentrations (about 51 ng/ml) occur approximately 2.5 hours after a single dose of Janine. Peak plasma concentrations of ethinyl estradiol (about 67 pg/ml) are achieved after 1.5-4 hours.

Dienogest is metabolized by hydroxylation and conjugation. Ethinyl estradiol is subject to presystemic conjugation both in the mucous membrane of the small intestine and in the liver.

The half-life of dienogest is approximately 8.5 - 10.8 hours. The derivatives Dienogest and Ethinyl estradiol are eliminated by the kidneys and biliary excretion.

Analogs

Janine is a non-unique drug; it can be replaced with other oral contraceptives. Popular analogues of the product are:

• Belara - combined tablets containing chlormadinone, ethinyl esradiol;
• Yarina - contraceptive pills based on ethinyl estradiol, drospirenone;
• Midiana is a contraceptive containing drospirenone and ethinyl estradiol;
• Logest - combined tablets based on gestodene and ethinyl estradiol;
• Lindinet 30 is a product based on the sex hormones ethinyl estradiol, gestodene;
• Mercilon is an estrogen-progestogen agent containing desogestrel, ethinyl estradiol;
• Marvelon - contraceptive pills based on ethinyl estradiol, desogestrel;
• Femoden is an estrogen-progestin medicine containing gestodene, ethinyl estradiol;
• Silhouette is a structural analogue of Janine, contains the same components;
• Qlaira is a drug based on dienogest and estradiol valerate; the pack contains 5 types of tablets;
• Visanne - tablets that contain only micronized dienogest.

Contraindications

It is forbidden to use Janine by women who have the following symptoms or illnesses:

• venous thrombosis;
• known hereditary or acquired predisposition to venous thromboembolism, such as resistance to activated protein C (including factor V Leiden), antithrombin III deficiency, protein C deficiency, protein S deficiency;
• arterial thrombosis;
• cerebrovascular diseases such as existing stroke, history of stroke;
• migraine with focal neurological symptoms;
• diabetes mellitus with signs of vascular damage;
• severe hypertension and dyslipoproteinemia;
• existing or previously present liver tumors;
• diagnosed or suspected hormone-dependent malignant tumors (for example, tumors of the genitals or mammary glands);
• vaginal bleeding of unknown cause;
• high sensitivity to the active components or to any of the additional ingredients of the medication.

Side effects

Adverse symptoms reported in clinical studies using Janine as an oral contraceptive are shown in the following table.

Compatibility of Janine with other drugs

After taking Janine and drugs that increase the clearance of gonadosteroids together, oral contraceptives may not work or cause bleeding.

Janine may interact with microsomal enzyme-inducing drugs (eg, phenytoin, barbiturates, primidone, carbamazepine, rifampicin, felbamate and St. John's wort). This may lead to increased clearance of gonadosteroids.

HIV protease (eg, ritonavir) and NRTIs (eg, nevirapine) and their groups have also been shown to affect liver function.

The use of certain antimicrobial agents (eg, penicillins, tetracyclines) may reduce the enterohepatic circulation of estrogens, including ethinyl estradiol.

Oral contraceptives may affect the way some other medications work. As a result, their accumulation in plasma and tissues may be increased (for example, cyclosporine) or decreased (for example, lamotrigine).

Steroid hormones affect biochemical parameters (eg, liver, thyroid, adrenal, and kidney function), plasma protein levels of certain substance-binding proteins (eg, corticosteroid-binding globulin), lipid and lipoprotein fractions, carbohydrate metabolism, coagulation, and fibrinol.

During pregnancy

Available data from epidemiological studies in the instructions indicate that the drug does not increase the likelihood of disruption of the embryonic development of children in women who took Zhanine shortly before pregnancy or some time after pregnancy (due to ignorance of the fact of pregnancy). At the same time, the manufacturer prohibits taking the drug during pregnancy and during breastfeeding. Hormonal contraceptives suppress lactation and change the composition of breast milk. After stopping the pills, pregnancy occurs within a short time.

Directions for use: Janine and dosage

Janine tablets are taken at approximately the same hour every day, as indicated on the package. You need to take Janine one tablet a day for 21 days without a break. A new package is started after a week's break, during which bleeding usually occurs. It usually starts on the second or third day after the last tablet and may not end by the time you start a new pack.

If hormonal contraceptives have not been used for a month, pills should be started on the first day of a woman's natural menstrual cycle.

If you have previously taken other oral contraceptives, then you should take Zhanine birth control pills the next day after taking the last pill of the previous contraceptive, but no later.

After termination of pregnancy in the first trimester, you can start drinking Janine immediately. In this case, additional mechanical contraceptive measures are not required.

After childbirth or after termination of pregnancy in the second trimester, women should be advised to start taking Janine at 21-28. If a woman starts taking the pill later, she should use an additional method of contraception during the first week of taking the pill.

If a dose is missed less than 12 hours apart, contraceptive protection will not be reduced. The woman should take the pill as soon as she remembers and continue taking the other pills at the previously chosen time.

If the pill is delayed for more than 12 hours, contraceptive protection may be reduced.

Stopping the pills should never last longer than 7 days.

In cases of severe gastrointestinal distress, resorption may be incomplete and additional contraceptive methods should be used. If vomiting occurs within 3-4 hours after consuming Janine, resorption may be incomplete. In this case, the new tablet should be taken as soon as possible.

If a woman wants to delay her period, she should continue taking Janine from the second package without a 7-day break. The delay can take as long as the woman wants until she has taken all the pills in another package.

Janine for the treatment of acne and seborrhea should be prescribed in accordance with the dosage and method of hormonal contraception. The duration of use depends on the nature of the disease. Treatment usually takes months. The duration of Janine’s treatment for acne and seborrhea is determined by the attending physician.

Drug interactions

The instructions for use of Janine talk about drug interactions between the drug and other medications. This may cause negative reactions:

1. Barbiturates, Rifampicin, hydantoins, Carbamazepine, Topiramate, Parimidon, Felbamate, Griseofulvin can reduce the contraceptive effect of the drug.
2. Ampicillins and tetracyclines can reduce the concentration of ethinyl estradiol.
3. When completing a course of Rifamcin, you should additionally use contraceptive measures for a month after the end of treatment.

special instructions

If anticoagulant therapy is initiated, it is advisable to initiate another form of contraception due to the teratogenicity of anticoagulant drugs (coumarins).

In rare cases, benign liver tumors and, much less frequently, malignant liver tumors have been reported in women using COCs. There have been cases where these tumors have led to intra-abdominal hemorrhage, which was life-threatening. If severe abdominal problems, liver enlargement, or signs of intra-abdominal bleeding occur, liver tumor should be included in the differential diagnosis.

Janine tablets contain sucrose. Patients with fructose intolerance, glucose-galactose malabsorption, or sucrose isomaltase deficiency should not use this medicine.

Women who suffer from hypertriglyceridemia or have a family history of this disease are at increased risk of acute pancreatitis when taking the drug.

Because any oral contraceptive may cause irregular bleeding, especially during the first months of use, it is recommended that the cause of irregular bleeding be investigated after approximately three adjustment cycles while taking Janine.

Janine

Irregular use can lead to intermenstrual bleeding and impair therapeutic and contraceptive reliability. Taking pills should never be interrupted for more than 7 days. 7 days of continuous administration of the pills are required to achieve adequate suppression of the hypothalamic-pituitary-ovarian system.

Before starting use, it is recommended to conduct a thorough general medical and gynecological examination (including examination of the mammary glands and cytological examination of cervical mucus) and exclude pregnancy. In addition, disorders of the blood coagulation system should be excluded.

In case of long-term use of the drug, it is necessary to carry out preventive control examinations every 6 months.

The woman should be warned that the drug does not protect against HIV infections (AIDS) and other sexually transmitted diseases.

Prescribing a combined contraceptive with antiandrogenic properties may be especially useful for patients with acne, seborrhea, hirsutism and androgenetic alopecia.

During the treatment period, prolonged exposure to the sun or UV irradiation should be avoided.

A number of epidemiological studies have revealed a slight increase in the incidence of venous and arterial thrombosis and thromboembolism when taking combined oral contraceptives. These cases are extremely rare.

Venous thromboembolism (VTE), in the form of deep vein thrombosis and/or pulmonary embolism, can develop during the use of all combined oral contraceptives. The estimated incidence of VTE in women taking oral contraceptives with low doses of estrogens (less than 50 mcg ethinyl estradiol) is up to 4 per 10 thousand women per year, compared with 0.5-3 per 10 thousand women not using oral contraceptives. However, the incidence of VTE developing when taking combined oral contraceptives is less than the incidence associated with pregnancy (6 per 10 thousand pregnant women per year).

In women taking combined oral contraceptives, extremely rare cases of thrombosis of other blood vessels, such as the hepatic, mesenteric, renal arteries and veins or retinal veins and arteries, have been described. The connection of these cases with the use of combined oral contraceptives has not been proven.

A woman should stop taking the drug and consult a doctor if symptoms of venous or arterial thrombosis develop, which may include unilateral leg pain and/or swelling; sudden severe chest pain; with or without irradiation to the left hand; sudden shortness of breath; sudden attack of cough; any unusual, severe, prolonged headache; increased frequency and severity of migraines; sudden partial or complete loss of vision; diplopia; slurred speech or aphasia; dizziness; collapse with or without partial seizure; weakness or very significant loss of sensation that suddenly appears on one side or in one part of the body; movement disorders; "acute" stomach.

The risk of thrombosis (venous and/or arterial) and thromboembolism increases: with age, in smokers (with increasing number of cigarettes smoked or increasing age, the risk further increases, especially in women over 35 years of age), with a family history (i.e. venous or arterial thromboembolism ever in close relatives or parents at a relatively young age), obesity (body mass index more than 30), dyslipoproteinemia, arterial hypertension, heart valve disease, atrial fibrillation, prolonged immobilization, major surgery, any surgery on the legs or extensive trauma. In these situations, it is advisable to stop using combined oral contraceptives (in the case of planned surgery at least 4 weeks before it) and not to resume use for 2 weeks after the end of immobilization.

The increased risk of thromboembolism in the postpartum period should be taken into account.

Circulatory abnormalities may also occur in diabetes mellitus, SLE, hemolyticouremic syndrome, Crohn's disease, ulcerative colitis, and sickle cell anemia.

Biochemical parameters that may indicate susceptibility to thrombosis include resistance to activated protein C, hyperhomocysteinemia, antithrombin III deficiency, protein C and S deficiency, antiphospholipid antibodies (anticardiolipin antibodies, lupus anticoagulant).

It should be taken into account that the risk of thrombosis during pregnancy is higher than when taking combined oral contraceptives.

An increased risk of cervical cancer with long-term use of combined oral contraceptives has been reported in some epidemiological studies. Its connection with the use of combined oral contraceptives has not been proven. Controversy remains regarding the extent to which these findings are related to sexual behavior and other factors such as human papillomavirus (HPV).

A meta-analysis of 54 epidemiological studies demonstrated that there is a slightly increased relative risk (RR=1.24) of developing breast cancer diagnosed in women who were using combined oral contraceptives at the time of the study. Its connection with the use of combined oral contraceptives has not been proven. The observed increased risk may be a consequence of earlier diagnosis of breast cancer in women using combined oral contraceptives.

In rare cases, the development of liver tumors has been observed during the use of sex hormones. If severe abdominal pain, liver enlargement, or signs of intra-abdominal bleeding occur, this should be taken into account when making a differential diagnosis.

Women with or a family history of hypertriglyceridemia may be at increased risk of developing pancreatitis when taking combined oral contraceptives.

Although slight increases in blood pressure have been described in many women taking combined oral contraceptives, clinically significant increases have rarely been reported. The relationship between taking combined oral contraceptives and increased blood pressure has not been established. However, if persistent, clinically significant arterial hypertension develops while taking them, it is advisable to discontinue combined oral contraceptives and treat hypertension. Taking combined oral contraceptives can be continued if normal blood pressure values ​​are achieved with antihypertensive therapy.

The following conditions develop or worsen both during pregnancy and when taking combined oral contraceptives, but their connection with the use of these drugs has not been proven: jaundice and/or itching associated with cholestasis; formation of gallstones; porphyria; SLE; hemolyticouremic syndrome; chorea minor (Sydenham disease); herpes during pregnancy; hearing loss associated with otosclerosis.

Acute or chronic liver failure may require discontinuation of combined oral contraceptives until liver function tests return to normal. Recurrent cholestatic jaundice, which develops for the first time during pregnancy or previous use of sex hormones, requires discontinuation of combined oral contraceptives.

Although combined oral contraceptives have an effect on tissue resistance to insulin and glucose tolerance, there is usually no need to adjust the dose of hypoglycemic drugs in patients with diabetes mellitus. However, they should be under close medical supervision.

Taking sex hormones can affect biochemical indicators of the function of the liver, thyroid gland, adrenal glands and kidneys, as well as the concentrations of plasma transport proteins, such as DSG and lipid/lipoprotein fractions, indicators of carbohydrate metabolism, coagulation and fibrinolysis.

Extensive epidemiological studies have not shown any increased risk of developmental defects in children born to women who received sex hormones before pregnancy, or teratogenic effects when sex hormones were inadvertently taken in early pregnancy.

Taking combined oral contraceptives may reduce the amount of breast milk and change its composition, so their use is generally not recommended during lactation. Small amounts of sex hormones and/or their metabolites may be excreted in milk, but there is no evidence of their negative effects on the health of the newborn.

While taking a combination of estrogen-progestogens, irregular bleeding may occur (“spotting” or “breakthrough” bleeding), especially during the first months of treatment. Therefore, assessment of any irregular bleeding is only meaningful after an adaptation period of approximately 3 cycles.

If irregular bleeding recurs or develops after previous regular cycles, non-hormonal causes should be considered and adequate diagnostic measures taken to exclude malignancy or pregnancy. These may include diagnostic curettage.

Some women experience withdrawal bleeding and pregnancy should be ruled out before continuing combined oral contraceptives.